Some 90% of people with private insurance receive it through an employer,
and those plans are generally priced using “pure” experience-rating. This
means the company serves as one giant risk pool, and a firm’s youngest
employees have the exact same insurance premium as their eldest colleagues.
The practice has roots in tradition and history;
unions started negotiating these kinds of contracts after World War II,
and other plans followed suit. But it’s also a matter of law: HIPAA and the
ADA
prohibit premium variation by health status. Age rating is constrained
somewhat—though not entirely—by the Age
Discrimination in Employment Act.

Yet, I’ve seen exactly zero Obamacare opponents railing to amend the
employer-based practices that require most young healthies to pay more than
their “fair share.” No one is plying Congress to amend HIPAA or the ADA so
young invincibles can pay premiums appropriate to their health status. No
one is calling out employers on their “redistributionist” policies, even
though uniform insurance premiums force a substantial transfer from the
young to the old. It makes histrionics over Obamacare’s 3:1 age band hard to
take seriously. ...

I know many conservative wonks find fault in ties between employment and
insurance, but they haven’t injected that into recent critiques. If
messaging around rate shock is more than opportunistic hackery—if it’s
genuinely about how “health insurance” ought to be conceived—why are they
leaving the most prevalent and most redistributive form of private coverage
unscathed? Surprise me.

Some 90% of people with private insurance receive it through an employer,
and those plans are generally priced using “pure” experience-rating. This
means the company serves as one giant risk pool, and a firm’s youngest
employees have the exact same insurance premium as their eldest colleagues.
The practice has roots in tradition and history;
unions started negotiating these kinds of contracts after World War II,
and other plans followed suit. But it’s also a matter of law: HIPAA and the
ADA
prohibit premium variation by health status. Age rating is constrained
somewhat—though not entirely—by the Age
Discrimination in Employment Act.

Yet, I’ve seen exactly zero Obamacare opponents railing to amend the
employer-based practices that require most young healthies to pay more than
their “fair share.” No one is plying Congress to amend HIPAA or the ADA so
young invincibles can pay premiums appropriate to their health status. No
one is calling out employers on their “redistributionist” policies, even
though uniform insurance premiums force a substantial transfer from the
young to the old. It makes histrionics over Obamacare’s 3:1 age band hard to
take seriously. ...

I know many conservative wonks find fault in ties between employment and
insurance, but they haven’t injected that into recent critiques. If
messaging around rate shock is more than opportunistic hackery—if it’s
genuinely about how “health insurance” ought to be conceived—why are they
leaving the most prevalent and most redistributive form of private coverage
unscathed? Surprise me.